International Leprosy Association - History of Leprosy

Leprosy as a Metaphor

When someone says the word leprosy, many images and connotations spring to mind. These meanings have developed and accumulated throughout history, and even though most people in the world will have never actually seen the effects of the disease, they still use the word and its meanings in a variety of contexts. These accumulated meanings lie heavily on someone who is diagnosed with the disease. The longstanding power of the metaphoric resonance of leprosy gives leprosy more significance than it should have. People who have worked in the field and people who have suffered from the disease have worked hard to make leprosy mean no more than any other disease. Irrespective of this, its connotations continue to reverberate.

In this section, I explore both the continuing history of the meanings attached to leprosy as a disease, the ways in which leprosy has been used as a metaphor for other things, and the deep-seated reasons why leprosy is so resonant. As such, this is an attempt to explain something of that heavy burden of accumulated representations that people encounter when they encounter leprosy.

Warning: Because I am exploring the history of metaphors attached to leprosy, I will of necessity be citing the derogatory and in some cases vicious usage that has no place in our references to the disease and to the people affected by the disease today.

Susan Sontag struggles with and attempts to uproot the metaphoric function of the language of disease and illness that is so permeated with blame in Illness as Metaphor and AIDS and Its Metaphors. She writes:

My subject is not physical illness itself but the uses of illness as a figure or metaphor. My point is that illness is not a metaphor, and that the most truthful way of regarding illness – and the healthiest way of being ill – is one most purified of, most resistant to, metaphoric thinking. Yet it is hardly possible to take up one’s residence in the kingdom of the ill unprejudiced by the lurid metaphors with which it has been landscaped. It is toward an elucidation of those metaphors, and a liberation from them, that I dedicate this inquiry. (3-4)

This metaphoric function of disease is Janus faced. Metaphors of disease are used to represent experience, and at the same time, specific illnesses become enshrouded with a metaphoric potency, and what they are taken to represent is often in excess of their materiality. Metaphors of disease thus assume an autonomy from the specific illness and bring themselves to focus on diverse phenomena, but return to their specific illnesses replete with associations. These metaphors mediate the “reality” of the illness and, in combination with everything that they take from and bring to the illness, in turn mediate completely unrelated events. They make their own contribution to that “intricate mosaic of knowledge relations” that provides momentary anchoring for subjects of disease categories. Sontag traces this Janus-faced metaphoric power:

Any important disease whose causality is murky, and for which treatment is ineffectual, tends to be awash in significance. First, the subjects of deepest dread (corruption, decay, pollution, anomie, weakness) are identified with the disease. The disease itself becomes a metaphor. Then, in the name of the disease (that is, using it as a metaphor), that horror is imposed on other things. The disease becomes adjectival. Something is said to be disease-like, meaning that it is disgusting or ugly. (58)

But in writing that “the disease becomes a metaphor,” Sontag fails to enact the very task which she sets for herself; she fails to notice how separate the metaphor actually is from the material illness. The metaphor takes upon itself its own life and gathers to itself its own associations – it departs from the illness and returns to it, with new connotations. It is already liberated from the illness in a way that Sontag does not acknowledge. The metaphoric function of disease forms its own autonomous discourse. Scheper-Hughes and Lock, medical anthropologists, write

Sickness is not just … an unfortunate brush with nature. It is a form of communication -the language of the organs – through which nature, society, and culture speak simultaneously. The individual body should be seen as the most immediate, the proximate terrain where social truths and social contradictions are played out, as well as a locus of personal and social resistance, creativity, and struggle. (31)

Not only do the metaphors for disease assume their own autonomy, the physical body becomes a metaphor for the social body. I want to argue that with leprosy both dimensions of representation are in operation. The way the disease is represented and the way the disease is used for representation both have a powerful autonomy that has no respect for the lived experience of illness. The categories established around and including medicine, disease, health, and the body form a metadiscourse. They produce a language through which a society reveals how it understands and expresses itself.

For the Greeks, the disease had a fearsome reputation. Paulus AEgineta uses another disease, cancer, to express an analogy with leprosy, writing that: “Well, in my opinion, did Aretaeus the Cappadocian say, that the power of remedies ought to be greater than those of diseases; and that for this reason elephantiasis is incurable, because it is impossible to find a medicine more powerful than it … It is a cancer of the whole body”; nonetheless, “we must attempt a cure.” (Adams 1)

The ability of leprosy to obliterate the boundaries of human identity added to leprosy’s protean character and ensured its pandemic metaphoric potency. The Greeks developed a metaphoric repertoire that expressed this. Aretaeus writes that the disease is called “elephas… from its magnitude, leontium or morbus leoninus, from the supposed resemblance of the eyebrows to those of the lion; and satyriasis, from the venereal desires with which it is attended” (8). Alsaharavius, an Arabian writer, categorised varieties of lepra: leonina, elephantia, serpentina, and vulpine. Adams commented that, following Alsaharavius, the “earliest of our modern writers on medicine” described four varieties: elephantia, leonina, alopecia, and tyria (14). At this point, the ravages of the disease became coded as metamorphoses – a degenerative descent from human to animal including a moral descent, into uncontrollable venery. For Aetius, the disease was accompanied by a “strong venereal appetite” (10). For Galen, the whole appearance of the victim resembled “that of a satyr” (10). It was also described as a cunning predator: “escaping notice at first, being deep-seated and preying upon the vitals …” (8). For Aetius, it is “insidious, for it begins in a concealed manner internally, and does not make its appearance upon the skin until it is confirmed” (10).

By the nineteenth century, leprosy has become a disease that can be contracted in the colonies and threatens a resurgence in Europe. The enduring power of the metaphoric resonance of leprosy is encoded in Erasmus Wilson’s case studies of eighteen Europeans and one native of Hindustan who had all lived in either India, Ceylon, Mauritius, or the West Indies. (Wilson 231-44) Each emerges as a narrative of a life and sometimes death, charted over time with the marks of disease and categorised according to race, gender, age, pursuit, and predecessors. These cases (along with a number of others) were circulated and recirculated in the debates about the disease which took place after the release of the Report of the Royal College of Physicians and up until the turn of the century. These descriptions tell us more about anxieties to do with colonization, underlying concerns about miscegenation and degeneration in the tropics than they have to do with the actual disease.

The collective effect of the symptoms of these cases is of a metamorphosis in disposition and physical appearance – a degenerative descent in which they are captured, in the case study, poised on the boundary between what constitutes a human being and something else. A mother notes alterations in “the appearance of (a child’s) countenance” (235) and a change in behaviour: “He shunned amusements; was fond of sitting alone and secluding himself” (235); the features of another developed changes which “gave an occasional gleam of savageness to his countenance” (237); another’s vital functions seem to slow down to the extent that she experienced “coldness of extremities … and a certain listlessness, heaviness, sleepiness, and indisposition for exertion of every kind.” (238) Another was “listless and dull in his manner” (238) and yet another was “dejected, listless, and melancholy”, unable to sleep at night and sitting for hours during the day “without occupation and without attempting to make any exertion” (238).

Their faces and their skin were altered. The face became “pallid”, “yellowish brown”, “reddish brown”, “leaden or purplish.” The features were “spread out”, “enlarged and flattened.” The skin became covered in spots which changed from “beautiful pink” to “purple” and finally “dirty brown.” It shone as if it were greasy. On the face, the skin thickened around the eyebrows, nose, lips, chin and ears giving the face “a frowning and dejected expression” (237). The facial hair fell out. In one case, the skin was “yellowish brown with a purplish almost livid blush” and “the brow was heavy and frowning, the eye sunken, anaemic, and glistening, and the general expression of features listless and melancholic” (237). Another looked like a Satyr

His features were large and of a deep red-brown or copper colour; the forehead was deeply wrinkled and studded with tubercles; two of the tubercles at the upper angles of the forehead resembling young horns; the brow was thickened, heavy, frowning and deprived of hair; the eyes suffused with redness … The voice was hoarse and sonorous … (239)

Another begins to look like “a native”

From his infancy he was somewhat darker in complexion than his brother and sister … but during the last few years, and especially the last twelve months, has become swarthy, and at present is darker than a native of India … (240)

The ability to speak deteriorated. The hands and feet altered, the bones retracting so that the shape was lost; for example,

(he) had lost a phalanx from the little finger of one of his hands, the rest of the fingers were bent in different directions and the hands distorted. He was unable to use his hands and was incapable of walking. (244)

Evidently incursions into the Empire were fraught with peril. Children, young men, young women, and old and distinguished men were not safe from becoming afflicted with leprosy: the inevitability of reversion and degeneration were embodied in the transformations brought about by this disease.

Leprosy made “Other” to the extent that the boundaries of what delineated a physical body were compromised, and this frightening and inexplicable process was simultaneously animalised, demonised, and conflated with “going native.” The storehouse of images or stereotypes at the end of the nineteenth century became externalised in leprosy, in the unfortunate person who had departed just like anyone of “us” from Great Britain, and, after a period of dwelling in the colonies, emerged transformed in the most terrifying and unimaginable way. The price to be paid for venturing away from “home” was loss of the defining characteristics that gave one entry into society and established one’s social identity. The marks of leprosy heralded a lingering process of dying in which one’s vitality lessened in agonisingly incremental degrees.

These anxieties ramified towards the end of the nineteenth century. In 1889, H. P. Wright, who had already written of his concerns in the Times, published Leprosy an Imperial Danger, in which he personified leprosy, demonized it, expressed its trajectory through metaphors of invasion, and, most significantly of all, equated the individual suffering from the disease with the disease itself – the person with leprosy became the disease. He wrote: ”In leper lands, that which produces leprosy is not the soil, as in malaria; nor water, as with so many infectious maladies; nor decaying food; nor destitution, as in lathyrism, pellagra, &c. It is the leper” (Wright, 1889, pp. 15, 37, 31, 12, 99, 86, 116, 122, 16). He suggested that “lepers” might ”fertilize” the soil with ”their bacilli and spores,” contaminating a district ”for a period more or less lengthy.” Consequently, if a person lived where “lepers” lived, even if they did not come into ”close proximity,” there was always the possibility that ”you may be attacked by the disease, and that in a very short period.” Eventually, in Wright’s rhetoric, an attack from the disease leprosy becomes a ”leper attack.” The disease was also given demonical dimensions. It ”manifests itself;” it is an evil that spreads with terrifying rapidity to be stamped out; it is a foul disease; ”a frightful scourge ever threatening, and slowly advancing;” and it ”threatens to become the scourge of the whole earth.” Its progress throughout history was figured as the ”rapid propagation of a scourge,” albeit an arbitrary one: sometimes moving slowly, sometimes with ”a fearful rapidity,” other times with a ”primitive intensity.” It invaded, attacked, abounded, prevailed, and ravaged. Most frighteningly, it was immortal: ”It is ever alive, ever reviving, threatening without cessation all who approach its haunts.” It was communicated between ”races,” and was a threat to the ”white races.” Any country ”which allows itself to be freely visited by a race infected with the malady” will itself be affected (Wright, 1889, pp. 5, 13, 14, 37, 39-40, 55, 92, 93); some were more ready to receive it than others: the yellow and black races were more susceptible than the white; although some races presented an “aptitude for maturing the leprous agent,” none “can claim absolute immunity”; it was caught from coloured men and slaves who had been given responsibility for caring for one’s children. He argued that it spread ”wherever an infected race” was ”brought into contact under favourable conditions with a non-infected one.” The invasion by leprosy and an invasion by another ”race” become indistinguishable, particularly where the Chinese were concerned: ”The invasion of a country by leprosy has always coincided with the introduction of lepers into that country; and races which have avoided intercourse with leprous people have remained intact.” Most importantly, Wright was explicit about the potential threat that leprosy posed to England. The disease, he predicted, ”will ruthlessly invade our colonies” and again become a “common scourge throughout Europe.”

If, as Sander Gilman argues, the representations of a disease provide insight into the sense of loss of control of a society, then the rich storehouse of stereotypes offered up by leprosy must indicate a genuine moment of Imperial anxiety during which the integration of the identity of the group was subjected to stress: “From a wide range of the potential models in any society, we select a model that best reflects the common presuppositions about the Other at any given moment in history” (20). Fear about illness and the corruption of the self, in the form of leprosy, was projected onto others so that the colonial world was “seen as both corrupt and corrupting, polluted and polluting” (23).

Gilman describes Western images of disease as being suffused, “contaminated,” with a “fear of collapse,” and a “sense of dissolution.” In their externalisation of the fear of loss of control, their changing functions can be mapped over time to reflect the image that a disease has within an age so that the representation of the disease can be used to indicate the sense of control and fears of disorder or collapse that are prevalent within that society. The way in which the disease is represented, what the disease represents, which disease is represented, and what it is applied to, in order to invest it with significance, betray the sense of the potential for disorder in a specific period in history:

Disease, with its seeming randomness, is one aspect of the indeterminable universe that we wish to distance from ourselves. To do so we must construct boundaries between ourselves and those categories of individuals whom we believe (or hope) to be more at risk than ourselves. These bounded categories are invested with all of the raw intensity of our pre-Oedipal selves.

Portrait of Thomas de Quincey by Sir John Watson-Gordon. (National Portrait Gallery, London.)

In The Infections of Thomas de Quincey, John Barrell claims that De Quincey was terrorised by fear of “an unending and interlinked chain of infections from the East, which threatened to enter his system and to overthrow it, leaving him visibly and permanently ‘compromised’ and orientalised” (15).

De Quincey’s fears were not literally diseases, but they were envisaged as such: “The ‘oriental leprosy’, ‘oriental cholera’, ‘oriental typhus fever’, the ‘plague of Cairo’, the ‘cancerous kisses’ of the Egyptian crocodile: the fear and hatred projected on to the East kept threatening to return in one such form or another …” (16) These disease threats, metaphors for an orientalism that was perceived as threatening to swamp the vulnerable Imperial self, were irrevocably entangled in involutes of personal associations, guilt, and fear. A disease, which was perceived as quite literally “Oriental” in origin, but also with the potential to make utterly “Other,” to Orientalise, could only indicate vast reservoirs of fear and anxiety in the society which organised itself to recognise, contain, and incarcerate it.

Sources

Francis Adams, The Seven Books of Paulus Aegineta: Translated from the Greek with Commentary Embracing a Complete View of the Knowledge Possessed by the Greeks, Romans and Arabians on All Subjects Connected with Medicine and Surgery, 3 vols. (London: Sydenham Society, 1846), p. 1. In Paulus Aeginta, in Adams, regimes which governed what entered or left the body and bathing and anointing were recommended: purging and vomiting in the appropriate seasons, draughts before meals, the flesh of vipers boiled in white broth (3), massage with the grease of a boar, wolf or goat (3), eating barley bread, potherbs, beet, lettuce radish, leeks, cabbage and capers, and natural sea baths (5).

John Barrell, The Infections of Thomas De Quincey (USA: Yale UP, 1991), 16.

Erasmus Wilson, “Observations on the True Leprosy or Elephantiasis, with Cases,” The Report of the Royal College of Physicians, 231-44. Wilson prefaces the individual cases with a summary of the enabling conditions for the disease along with a discussion of the difference between leprosy and syphilis. From his observation of the cases living in countries in which the disease is endemic “predisposes to its attack, while birth in an infected country takes the place of long residence.” All are Europeans, except one, and all from the colonies: a sixteen year old boy, born in Ceylon and vaccinated, for smallpox, with attenuated bacteria from a native child; a young man of seventeen years, born in Bombay; a 21 year old male, born in Jamaica; a young woman who had been living in Mauritius; a 43 year old captain in the Indian army; a 60 year old man “in the judicial service of India” who had lived in the East for nearly 20 years; a captain in the Indian army; a 60 year old colonel who had lived in the West Indies; a 26 year old wife of an officer in the Indian army; a 19 year old Hindostan woman; a young medical officer in the Indian army who had originally contracted syphilis; “one of the chiefs of the Bengal medical establishment” (242) who had lived in India for 40 years; a merchant in Mauritius for 29 years; and the older brother of the sixteen year old.